Mild Fetal Tricuspid Regurgitation in the First Trimester as a Predictor of Perinatal Outcomes

Background and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312–0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080–2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient −6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation.

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Maternal and Perinatal Outcomes Among Pregnancies Complicated by Isolated Oligohydramnios Compared with Normal Amniotic Fluid Index

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v11i2.17458 ◽

2017 ◽

Vol 11 (2) ◽

pp. 32-36

Author(s):

Ramesh Shrestha ◽

DK Uprety ◽

A Thakur

Keyword(s):

Caesarean Section ◽

Amniotic Fluid ◽

Gestational Age ◽

Caesarean Section Rate ◽

Perinatal Outcomes ◽

Fluid Volume ◽

Labour Induction ◽

Control Group ◽

P Value ◽

Amniotic Fluid Index

Aims: The study was aimed to compare the maternal and perinatal outcomes among pregnancies with isolated oligohydramnios compared to normal amniotic fluid volume between 37-42 weeks.Methods: It was a prospective cohort study done among the singleton pregnancies between 37-42 weeks with isolated oligohydramnios taken as cases (n=100) and pregnancies with normal levels of amniotic fluid matched to cases by gestational age and parity in 2:1 ratio fulfilling the inclusion criteria were taken as controls (n=200). Both the mother and baby were followed up till discharge for outcomes.Results: Majority of the patients (n=300) were of age group 20-30 years (79.0%). Most of them (n=300) were primigravida (74.0%). The overall caesarean section rate was 24.66% (n=300). In the oligohydramnios group, 43.0% had undergone induction of labour (p value<0.05), 63.0% had undergone caesarean section (p value=0.001) and the most common indication for caesarean section was non-reassuring NST (44.44%) (p value<0.05). 26.0% babies had low birth weight, 12% had birth defects, 10.0% were small for gestational age (p value<0.05). There were significantly more ICU admission (13.0% vs 3.5%), early neonatal death (6.0% vs 1.5%), fetal distress (6.0% vs 1.5%) in the oligohydramnios compared to control group ( p value<0.05).Conclusions: Patients with oligohydramnios have increased labour induction, increased operative interferences and increased neonatal mortality and morbidity compared to patients with normal fluid volume.

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Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.03.269 ◽

2016 ◽

Vol 62 (3) ◽

pp. 269-275 ◽

Cited By ~ 9

Author(s):

Alex Sandro Rolland Souza ◽

Adriane Farias Patriota ◽

Gláucia Virgínia de Queiroz Lins Guerra ◽

Brena Carvalho Pinto de Melo

Keyword(s):

Amniotic Fluid ◽

Pregnant Women ◽

Gestational Age ◽

Perinatal Outcomes ◽

Perinatal Complications ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Amniotic Fluid Index ◽

Apgar Scores ◽

Preterm Premature Rupture

SUMMARY Objective: To determine the association between amniotic fluid index (AFI) and perinatal outcomes in preterm premature rupture of membranes (PPROM). Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR) and 95% confidence intervals (95CI). Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI<5cm and AFI>5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI<3cm), there was a higher frequency of Apgar scores less than seven at 1 minute, neonatal sepsis and early neonatal mortality compared to those presenting AFI>3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

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Perinatal outcomes in women affected by different types of headache disorders: A prospective cohort study

Cephalalgia ◽

10.1177/03331024211029236 ◽

2021 ◽

pp. 033310242110292

Author(s):

Isabella Neri ◽

Daniela Menichini ◽

Francesca Monari ◽

Ludovica Spanò Bascio ◽

Federico Banchelli ◽

...

Keyword(s):

Migraine With Aura ◽

Gestational Age ◽

Small For Gestational Age ◽

Migraine Without Aura ◽

Perinatal Outcomes ◽

First Trimester ◽

Tension Type Headache ◽

Headache Disorders ◽

Aneuploidy Screening ◽

Type Headache

Objective This study aims to investigate pregnancy and perinatal outcomes in women with tension-type headache, migraine without aura and migraine with aura by comparing them to women without any headache disorders. Study design Prospective cohort study including singleton pregnancies attending the first trimester aneuploidy screening at the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results A total of 515 consecutive women were included and headache disorders were reported in 43.5% of them (224/515). Tension-type headache was diagnosed in 24.3% of the cases, while 14% suffered from migraine without aura and 5.2% from migraine with aura. Birthweight was significantly lower in women affected by migraine with aura respective to other groups, and a significantly higher rate of small for gestational age infants was found in tension-type headache (10.4%) and in migraine with aura (24.9%) groups respective to the others (p < 0.001). Moreover, the admission to the neonatal intensive care unit was significantly higher in all the headache groups (p = 0.012). Multivariate analysis showed that women presenting tension-type headache (OR 4.19, p = 0.004), migraine with aura (OR 5.37, p = 0.02), a uterine artery pulsatility index >90th centile (OR 3.66, p = 0.01), low multiple of the median (MoM) of Pregnancy-associated plasma protein-A (PAPP-A) (OR 0.48, p = 0.05) and high MoM of Inhibin-A (OR 3.24, p = 0.03) at first trimester, are independently associated with the delivery of small for gestational age infants when compared to women without headache disorders. Conclusion Migraine with aura and tension type headache expose women to an increased risk of delivering small for gestational age infants, in association with some utero-placenta markers evaluated at first trimester. These women with headache disorders have an additional indication to undergo first trimester aneuploidy screening and would possibly benefit from specific interventions.

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Frequency of Caesarean Section in Pregnancies with Borderline Amniotic Fluid Index at Term

Annals of King Edward Medical University ◽

10.21649/akemu.v23i2.1559 ◽

2017 ◽

Vol 23 (2) ◽

Author(s):

Natasha Bushra ◽

Khaula Zeeshan ◽

Sara Ejaz ◽

Javeria Mushtaq ◽

Khadija Waheed ◽

...

Keyword(s):

Caesarean Section ◽

Amniotic Fluid ◽

Gestational Age ◽

Cross Sectional Study ◽

Induction Of Labour ◽

Amniotic Fluid Index ◽

Cross Sectional ◽

Increased Risk ◽

Failed Induction ◽

One Year

AbstractThe increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives: To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results: Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion: It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.

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The possibility of modifications methods of determine volume of amniotic fluid

Journal of obstetrics and women s diseases ◽

10.17816/jowd65312-17 ◽

2016 ◽

Vol 65 (3) ◽

pp. 12-17

Author(s):

Viktor A Mudrov

Keyword(s):

Body Mass Index ◽

Amniotic Fluid ◽

Pregnant Women ◽

Body Mass ◽

Gestational Age ◽

First Trimester ◽

Fetal Weight ◽

Abdominal Circumference ◽

Pregnancy And Childbirth ◽

Maternity Hospitals

Selection of the optimal tactics of pregnancy and childbirth significantly depends on the expected volume of amniotic fluid. The amount of amniotic fluid reflects a condition of a fetus and changes at pathological conditions of both a fetus, and an uteroplacental complex. The aim of the study was a modification of methods for determining the expected volume of amniotic fluid. On the basis of maternity hospitals Trans-Baikal Region in the years 2013-2015 was held retrospective and prospective analysis of 300 labor histories, which were divided into 3 equal groups: 1 group - pregnant women with a body mass index (BMI) for Quetelet less than 24, Group 2 - with a BMI from 24 to 30, group 3 - with a BMI more than 30. In order to determine the expected volume of amniotic fluid were used the subjective method, the Chamberlain’s and Phelan’s methods. The error in determining volume of amniotic fluid by the existing methods exceeds 10 %, that defined need of creation of a quantitative method. On the basis of mathematical and 3d-modeling of the volume of amniotic fluid and fetal weight determined pattern change, which is expressed by the formula: VAF = IAF × М × π / GA2, where IAF - index of amniotic fluid (mm), M - fetal weight (g), GA - gestational age (weeks). Through a comprehensive analysis of anthropometric research of the pregnant women defined formula’s volume of amniotic fluid: V = 0,017 × HUF × (AC - 25 × BMI / GA)2 - М, where GA - gestational age (weeks), AC - abdominal circumference of the pregnant women (cm), BMI - body mass index for Quetelet in the first trimester of pregnancy (kg/m2), HUF - height of an uterine fundus (cm), M - the estimated fetal weight (g). In calculating volume of amniotic fluid according to the proposed ultrasonic formula error does not exceed 5,3 %, anthropometric formula error does not exceed 10,2 %. Thus, the method has a smaller error compared to the standard, and can be used to reliably determine volume of amniotic fluid in II and III trimester of pregnancy.

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Comparison of Amniotic Fluid Index and Single Deepest Vertical Pocket

Current Women s Health Reviews ◽

10.2174/1573404817666210223162752 ◽

2021 ◽

Vol 17 ◽

Author(s):

Roopa Padavagodu Shivananda ◽

Rekha Anbu ◽

Shubha Rao ◽

Nivedita Hegde ◽

Anjali Suneel Mundkur ◽

...

Keyword(s):

Birth Weight ◽

Amniotic Fluid ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fluid Volume ◽

Maternal Outcomes ◽

Amniotic Fluid Index ◽

Amniotic Fluid Volume ◽

Vaginal Deliveries ◽

Nicu Admission

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the amniotic fluid index (AFI) in comparison to the single deepest vertical pocket (SDVP). Methods: We studied abnormal Cardiotocograph, meconium stained amniotic fluid, birth weight <2.5kg, Apgar score at 5 min <7, cord blood pH <7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of >5cm and SDVP of >1.9cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5kg and avoiding NICU admissions, an AFI of > 5.8cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

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Comparison of Amniotic Fluid Index at Different Gestational Age in Normal Pregnancy

Journal of Women s Health Care ◽

10.4172/2167-0420.1000377 ◽

2017 ◽

Vol 06 (04) ◽

Author(s):

Francis Olayemi Adebayo ◽

Olatunde Onafowokan ◽

Akinola Babalola ◽

Nathaniel Adewole ◽

Benjamin Nggada

Keyword(s):

Amniotic Fluid ◽

Gestational Age ◽

Normal Pregnancy ◽

Amniotic Fluid Index

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Perinatal outcome in uncomplicated pregnancies with oligohydramnios

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185426 ◽

2018 ◽

Vol 8 (1) ◽

pp. 215

Author(s):

Snehal Gaware ◽

V. B. Bangal

Keyword(s):

Birth Weight ◽

Amniotic Fluid ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Induction Of Labor ◽

P Value ◽

Amniotic Fluid Index ◽

Medical College ◽

Time Of Admission ◽

Singleton Pregnancies

Background: Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. We aimed to assess the perinatal outcomes in pregnancies with oligohydramnios.Methods: The prospective study was conducted in the Department of Obstetrics and Gynecology, Pravara Medical College, Loni in which 200 consecutive singleton pregnancies delivered vaginally, with intact membranes were included. Amniotic fluid index was determined using the Phelan’s technique at the time of admission and women were diagnosed with oligohydramnios if AFI was five or less, which formed the first group and the rest of mother formed the second group. Perinatal outcomes were noted in the proforma as well.Results: Of the 200 mothers included in the study, 38 had AFI ≤ 5. Baseline characteristics was similar in both the groups. Most common antenatal risk factors studies were pregnancy induced hypertension (29% vs 12%; p value <0.05), intrauterine growth restriction (34% vs 10%; p value <0.001) and severe anemia (21% vs 9%; p value <0.05). Proportion of pregnancies needing induction of labor and birth weight less than 2.5 kgs were significantly higher among mothers with oligohydramnios.Conclusions: Authors observed that induction of labor and low birth weight were significantly associated with oligohydramnios. Prospective randomized trials are needed to establish whether early induction of labor in the presence of a oligohydramnios improves perinatal outcome.

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